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RC1 48  .M85  Rabies  and  how  to  pr 


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P.ABIES  MD  HO'  TO  PREVEIMT    IT 


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Rabies  and  How  to  Prevent  It. 


J^    F^PER 


READ  BEFORE  THE 


American  Social  Science  Association, 


S-A.PI.A.TOG-A.,     SEI'TEIwfrBEK.     8,      1886 


VALENTINE    MOTT,    M.    D., 
New  York. 


BOSTON : 

PRESS  OF  GEO.   E.   CROSBY  &  CO.,  383  WASHINGTON  STREET. 

1887. 


•  M  ^  ^^ 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/rabieshowtopreveOOmott 


RABIES  AND  HOW  TO  PREVENT  IT. 


BY  VALENTINE  MOTT,  M.  D.,  OF  NEW  YOBK. 


Essentially  an  old  disease,  despite  of  what  many  say,  since  we 
find  mention  of  it  in  old  Latin  and  Greek  authors,  —  it  is  proba- 
ble that  the  name  of  none  of  the  ills  inflicted  on  suffering  human- 
ity strikes  with  such  dire  effect  upon  the  ordinary  mind  as  does 
this  one  word, —  rabies  or  hj^drophobia.  For  many  j-ears  this  last 
term  has  been  applied  more  especially  to  the  disease  as  it  mani- 
fests itself  in  the  human  being,  but  even  in  this  case  it  is  a  misno- 
mer, and  the  sooner  it  is  done  away  with  and  banished  from  both 
scientific  and  ordinary  dictionaries  the  better.  Derived  from  the 
two  Greek  words  hudor,  water,  phobos,  fear,  it  indicates  a  symptom 
found  in  certain  cases  in  man,  but  by  no  means  invariably,  and 
only  rarely  met  with  in  dogs  and  other  animals.  The  apparent 
dread  of  all  liquids  in  man  is  more  especially  intensified  by  the 
fact  that  all  attempts  to  swallow  are  extremely  painful,  even  in  the 
case  of  solid  food,  and  spasm  of  the  larynx,  pharynx  and  (Esopha- 
gus being  brought  about  by  the  attempted  ingestion  of  liquids. 
There  is  no  fear  of  the  liquid  itself ;  it  is  the  paroxysm  that  is 
almost  certain  to  follow  its  being  swallowed  or  even  an  attempt  at 
swallowing  it,  that  is  much  feared  and  dreaded  by  the  human 
being.  Because  a  dog  drinks  water  let  not  the  mistake  be  made 
of  saying  that  he  is  not  sufl^ering  from  rabies.  During  the  first 
stages  of  the  disease,  the  dog  drinks  water  ravenously,  and  even 
after  the  constriction  has  taken  place  in  the  throat,  which  renders 
its  deglutition  difficult,  the  mad  dog  will  push  his  head  deep  into 
the  water  and  try  to  force  it  down.  Dogs  have  been  known  to 
swim  rivers  during  the  ferocious  stage,  and  in  many  cases  described 
by  the  most  competent  authorities  water  has  not  only  been  drank, 
but  taken  in  such  exceptionally  large  quantities  as  to  cause  re- 
mark. Let  not,  then,  the  fact  that  the  suspected  dog  drinks  water 
lead  any  one  to  pronounce  the  bitten  person  free  from  danger,  and 
not  in  need  of  precautionary  and  preventive  treatment,  as  has 
been  done  before  this  and  serious  results  followed. 

To  this  end  let  us  do  away  with  the  word  hydrophobia,  and  sub- 
stitute the  more  generic  term  rabies.     Let  this  term  be  used  by  all 


to  denote  the  disease  caused  by  the  specific  poison  generated  in 
tiie  dog,  cat,  fox,  jackal,  hyena  and  wolf,  manifested  b}'  certain 
symptoms  referable  to  the  nervous  and  secretory  systems,  and  ca- 
pable of  being  transmitted  by  inoculation  (more  especially  by  the 
bites  of  these  animals)  to  man  and  almost  all  warm-blooded  ani- 
mals. This  disease,  when  once  manifested,  is  almost  invariably 
fatal ;  in  fact,  those  cases  reported  as  cured  are  to  a  great  measure 
doubtful,  being  probably  what  is  known  as  pseudo-hydrophobia  — 
the  result  of  an  over-wrought  imagination.  This  state  undoubt- 
edly exists,  and  in  certain  cases  death  results  from  it,  so  great  is 
the  power  of  the  mind  over  the  body.  Nor  is  the  state  always 
recognized,  and  it  is  only  by  Gubsequent  experiment,  namely',  the 
inoculation  of  dogs  and  rabbits  from  the  brain  and  cord  of  the 
subject,  and  their  becoming  or  not  becoming  affected  with  rabies, 
that  a  correct  diagnosis  of  what  the  disease  was  can  be  arrived 
at. 

Rabies  was  feared  b}'  the  ancient  Greeks  and  we  find  it  men- 
tioned b}"  Aristotle  and  undoubtedly  referred  to  in  Homer,  Euripi- 
des and  Hippocrates.  Celsus,  the  celebrated  physician,  who  lived 
during  the  century  before  the  Christian  era,  described  it  well  in 
his  "  De  Medicina,"  and  recommends  those  measures  which  have 
been  deemed  so  efficacious  in  modern  times, — namely,  caustics, 
burning,  cupping,  and  the  sucking  of  the  wounds  of  those  bitten 
by  rabid  dogs.  Paulus  ^gineta,  in  his  work  entitled  "  De  Re 
Medicina,"  gives  a  good  account  of  rabies  in  the  human  being, 
enumerating  the  symptoms  as  described  by  previous  authors,  of 
which  there  were  man}',  and  dividing  it  into  two  essential  varieties, 
namely :  That  produced  from  the  specific  poison  of  the  bite  of  a 
rabid  animal  and  always  fatal,  and  the  purel}'  nervous  or  pseudo- 
hydrophobia  produced  by  other  causes.  Authors  in  various  lan- 
guages have  followed  the  lead  of  these  forefathers  of  medicine, 
and  in  every  tongue  we  find  descriptions  of  rabies,  together  with 
infallible  nostrums  for  its  cure.  Not  only  were  external  remedies 
recommended,  but  also  internal  treatment  of  the  most  nauseous 
kind,  and  even  religion  itself  was  called  to  the  aid  of  those  af- 
flicted or  likel}'  to  be  afflicted  after  bites,  and  the  good  St.  Hubert 
was  invoked,  and  certain  ceremonies  performed  at  his  shrine  in 
order  to  obtain  immunity  therefrom. 

Many  epizootics  of  rabies  have  occurred,  and  it  ma}'  almost  be 
said  that  no  place  is  absolutely  free  from   its  ravages,  though  it 


seems  to  be  most  frequently  found  in  France,  Germany,  upper 
Italy  and  Holland.  Great  Britain  is  by  no  means  free  from  it,  and 
in  Russia  it  is  frequent,  especially  among  the  wolves  that  infest 
that  country.  In  this  country,  to  my  mind,  it  undoubtedly  exists 
at  times  —  during  the  last  year  to  a  greater  extent  than  for  some 
time  before,  far  more  cases  having  been  brought  to  the  attention 
of  the  public  at  large  through  the  press. 

As  regards  the  question  of  the  spontaneous  origin  of  rabies  in 
the  dog,  no  point  in  connection  with  this  disease  has  been  more 
thoroughly  discussed,  and  in  no  case  have  the  authorities  come  to 
so  little  conclusion.  To  me  it  seems  still  a  doubtful  point,  with 
the  weight  of  the  evidence  in  favor  of  spontaneity.  Undoubtedly 
the  great  majority  of  cases  are  of  a  traumatic  origin,  but  the  dis- 
ease must  at  one  time  or  another  have  had  an  origin,  and  we  hear 
of  a  number  of  cases  in  which  it  is  utterly  impossible  to  trace  any 
bite  from  a  dog  alreadj'  mad.  For  a  long  time  it  was  supposed 
that  the  season  of  the  year  had  an  influence  in  determining  the 
existence  of  madness,  and  the  term  "  dog-days"  has  become  uni- 
versally used  in  the  English  language  to  designate  that  hot 
weather  during  which  the  dog  was  most  likely  to  be  taken.  Sta- 
tistics, however,  seem  to  point  out  that  April  and  May  are  the 
months  during  which,  perhaps,  the  outbreak  of  the  disease  is  the 
most  prevalent ;  though  there  is  only  a  slight  difference,  and  it 
would  seem  as  though  it  were  as  prevalent  in  the  winter  months 
as  in  the  summer,  a  fact  startling  though  true.  It  does  not  seem 
as  though  warm  climates  tended  to  increase  the  disease ;  in  fact, 
the  contrary  may  almost  be  said  to  be  true,  as  we  find  it  more  fre- 
quently in  the  temperate  zone.  Many  have  maintained  that  the 
disease  only  existed  in  the  male,  or,  at  all  events,  that  the  female 
was  comparatively  free  from  it.  The  first  statement  is  absolutely 
false,  in  one  case  a  whole  pack  of  female  hounds  being  attacked 
by  it ;  and  the  second  being  well  accounted  for  by  the  fact  that 
the  dogs  outnumber  the  bitches  to  a  great  excess,  there  being,  I 
believe,  in  the  state  of  New  York  alone,  seven  dogs  to  every 
bitch. 

We  will  now  take  up  some  of  the  more  characteristic  symptoms 
of  rabies  as  manifested  by  the  dog, —  symptoms  it  would  be  well 
for  every  one  to  know  and  guard  against,  by  having  the  suspected 
animal  confined  and  carefully  watched,  so  that  any  outbreak  might 
be  warded  off.     In  case  any  one  has  been  bitten  it  is  far  better 


6 

that  the  dog  should  be  allowed  to  live,  so  that  it  might  be  watched 
and  the  people  put  out  of  their  suspense,  should  the  dog  not  be 
mad.  Death  will  ceitainl}'  follow  inside  of  ten  days,  should  the 
dog  be  suffering  from  rabies  ;  in  the  majority  of  cases  on  the 
fourth,  fifth  or  sixth  daj-  after  the  appearance  of  the  first  symp- 
toms of  the  disease. 

The  dog  attacked  with  rabies  in  the  beginning  does  not  show 
any  violent  symptoms  of  madness  or  fury,  he  does  not  bite,  but 
rather  becomes  more  affectionate,  licking  the  hands  and  face  of 
those  whom  he  has  been  attached  to.  Even  at  this  period  the  sa- 
liva is  poisonous,  and  inoculation  ma}'^  take  place.  It  soon  after 
begins  to  be  more  morose  and  sullen,  tries  to  hide  itself  away,  but 
not  content  with  any  one  place  or  position,  is  restless  and  change- 
able, and  wears  a  far-off  look  in  the  eyes,  snaps  and  barks  at 
imaginary  objects.  It  still,  however,  continues  obedient  to  its 
master,  (and  this  continues  to  a  great  extent  through  the  whole 
disease,)  acknowledging  his  power  and  seeking  to  compl}'  with  his 
commands.  The  desire  to  bite  is  soon  developed  and  manifests 
itself  in  the  first  place  against  iuanimate  bodies  —  pieces  of  wood, 
stones,  matting,  rugs,  in  fact,  anything  that  may  be  near  it,  all  of 
which  goes  to  form  a  mass  in  the  stomach,  which  is  regarded  as 
one  of  the  post-mortem  characteristics  of  rabies.  It  now,  if  pos- 
sible, escapes  from  home  and  rushes  around  the  country,  its  anger 
being  more  especiall}^  developed  by  the  sight  of  other  dogs,  whom 
as  a  rule  it  immediately  attacks  and  bites.  In  fact,  though  a  rabid 
dog  ma}^  be  in  the  quiescent  state,  upon  the  approach  of  another 
dog  access  of  fury  will  be  developed  and  a  violent  onslaught  will 
be  made.  The  well  dog,  recognizing  by  some  unknown  process 
the  presence  of  danger,  will  slink  awaj',  even  though  more  power- 
ful, and  try  to  escape.  Early  in  the  disease  a  peculiar  bark  is 
developed,  which  is  known  as  the  cock-crow,  resembling  this  in  a  j 
certain  way  ;  the  first  note  of  each  three  successive  howls  remain- 
ing constant,  the  second  notes  being  in  an  ascending  scale  one 
tone  apart,  the  last  being  the  octave  of  the  first  note.  There  is 
no  fear  of  water,  and  although  there  ma}-  be  foaming  at  the  mouth 
it  is  b}'  no  means  a  constant  symptom.  A  peculiar  characteristic  ' 
in  the  mad  dog  is  the  absence  of  the  sense  of  pain  ;  a  red-hot 
poker  will  be  grasped  and  held  on  to.  Dogs  will  bite  themselves  j 
and  still  utter  no  cr}'.  Periods  of  calm  succeed  these  accesses,  j 
the  danger  from  inoculation  still  existing.     Exhausted  b}'  the  par- 


oxysms  and  the  fighting  it  has  done,  the  dog  will  still  continue  on, 
in  its  unsteady  gait,  with  the  tail  between  its  legs,  eyes  wander- 
ing, and  head  rolling  from  side  to  side,  and  the  mouth  open  and 
tongue  protruding,  until  at  last^  entirely  gone,  it  will  lie  down  to 
die  of  asphyxia  and  paralysis.  What  is  known  as  dumb  madness 
rarely  affects  dogs,  though  when  rabies  is  communicated  to  rab- 
bits by  inoculation  and  introduction  of  rabid  material  under  the 
dura  mater,  tliis  variety  obtains  in  99  cases  out  of  100.  Its  dis- 
tinctive characteristic  is  paralysis.  In  it  the  lower  jaw  hangs 
down,  the  saliva  pours  from  the  mouth,  motion  becomes  less  and 
less,  and  the  animal  dies  a  comparatively  painless  death,  the  func- 
tions of  the  various  organs  of  the  body  gradually  being  suspended. 

In  the  human  being,  the  first  symptoms  of  the  fatal  attack  seem 
to  be  a  peculiar  itching  of  the  old  wound  and  the  spread  of  neu- 
ralgic pains  from  it  toward  the  nerve  centres  ;  a  general  feeling  of 
malaise  and  an  impending  dread  of  something  frightful  about  to 
happen ;  there  is  a  tightness  about  the  throat  and  difficulty  in 
swallowing ;  breathing  becomes  affected  and  there  is  oppression 
over  tlie  whole  chest.  Violent  paroxysms  follow,  showing  evidently 
that  the  whole  nervous  system  is  in  a  most  frightfully  excited 
state  —  a  ray  of  light,  a  breath  of  wind  on  an  exposed  part  of  the 
body,  the  sight  of  water  sometimes,  the  constriction  following  an 
attempt  to  swallow  it,  greatl}'  craved  though  it  may  be,  are  sufficient 
to  determine  a  spasm.  Ropy,  viscid  mucus  is  secreted  by  the  salivary 
glands  and  vehemently  expelled  from  the  mouth.  Violent  convul- 
sions of  the  larynx  and  pharynx  take  place,  in  many  cases  closing 
the  windpipe  and  preventing  the  access  of  air.  Hallucinations 
come  on  and  sometimes  wild  delirium.  During  the  interval  of  the 
attacks,  the  sufferer  is  often  calm  and  rational,  and  in  many  cases, 
feeling  the  approaching  access,  begs  to  be  restrained  so  that  he 
may  do  no  harm.  Paralj'sis  finally  supervenes,  and,  totally  ex- 
hausted, death  mercifully  relieves  the  sufferer.  True  rabies  is 
necessarily  fatal  in  the  present  state  of  our  scientific  knowledge. 
Drugs  and  treatment  of  every  kind,  sort  and  description  have  been 
tried  without  avail ;  all  that  can  be  done  is  to  attempt  to  relieve 
the  frightful  symptoms  as  best  we  can  ;  and  it  is  certain^  justifi- 
able to  try  any  remedy  that  holds  out  the  slightest  chance  of  af- 
fording even  a  minimum  of  relief,  to  say  nothing  of  anything  that 
might  effect  a  cure. 

The  period  of  incubation  of  rabies  is  very  variable,   different 


8 

authorities  giving  the  shortest  period  in  the  clog  at  from  5  to  10 
days  (Renault),  and  the  longest  14  months  (Haubner),  the  major 
ity  of  cases  occurring  in  from  three  to  seven  v^eeks  after  the  bite. 
In  the  human  being  the  ordinary  period  of  incubation  is  six  weeks, 
though  cases  have  been  noted  in  which  the  period  was  only  two 
days,  and  others  which  extended  over  four  and  five  years  (Tham- 
haym).  As  regards  the  likelihood  of  having  rabies  after  having 
been  bitten  by  a  rabid  dog,  the  authorities  are  also  at  variance, 
though  at  the  present  time  it  is  about  fair  to  say  that  about  16  per 
cent,  of  those  bitten  are  affected.  (Holmes  and  Leblanc,  a  veteri- 
nary of  Paris.)  Others  make  the  percentage  of  escape  60.  Again, 
out  of  320  cases  12S  perished,  making  40.31  per  cent.  (Bouley)  ; 
in  another  lot  33  per  cent,  died  (Renault)  ;  and  again,  in  24  cases 
only  one  died  (John  Hunter) .  Van  Buren  says  that  two  out  of 
three  bitten  have  rabies.  i 

As  regards  prevention  —  undoubtedly  in  the  first  place  the 
wound  should  be  cauterized,  no  matter  what  subsequent  course  is 
to  be  pursued.  Let  water  be  dashed  over  the  wound  so  as  to 
cleanse  it,  and  apply  immediately  nitric  acid.  This,  to  my  mind, 
is  infinitely  better  than  nitrate  of  silver,  carbolic  acid,  or  the  ac- 
tual cautery,  any  of  which  may  be  used  in  the  absence  of  the  first- 
named.  To  make  assurance  doubly  sure,  the  part  bitten  may  then 
be  excised,  and  the  wound  again  cauterized.  I  am  opposed  to 
the  method  of  sucking  the  wound,  as  it  exposes  another  person  to 
danger. 

For  over  five  years  experiments  have  been  going  on  in  the 
laboratory  of  the  Ecole  Normale  in  the  Rue  d'Ulm,  Paris,  seek- 
ing to  attain  this  great  end  —  the  prevention  of  rabies  —  and  this 
end  has  been  attained.  The  master  mind  in  prophylactic  treat- 
ment and  destruction  of  disease  was  at  work,  and  he  who  dis- 
covered the  principles  of  acetic  fermentation,  the  cause  and  means 
of  prevention  of  the  silk-worm  sickness,  inoculation  as  a  preven- 
tion of  anthrax,  etc.,  has  given  the  world  one  more  great  gift,  and 
put  all  nations  in  his  debt.  This  method  is  no  child  of  the  mo- 
ment. Pasteur  has  given  it  years  of  thought  and  rigid  research, 
and  now  shines  forth  triumphant  in  its  success,  a  blessing  to  hu- 
manity. 

On  the  30th  of  May,  1881,  Pasteur,  in  conjunction  with  his  as- 
sistants, Chaniberland,  Roux  and  Thuillier,  made  a  report  to  the 
Academ}'  of  Sciences,  that,  despite  of  previous  experiments  to  the 


contrary,  the  spinal  chord,  and  more  especially  the  medulla  oblon- 
gata, contained  the  specific  rabic  poison,  and  that  in  order  to  ren- 
der the  inoculation  more  certain,  the  poison  should  be  injected  un- 
der the  dura  mater,  by  means  of  trepanation  and  not  subcutane- 
ously.  At  the  same  time,  by  this  method  the  period  of  incubation 
became  more  fixed,  not  exceeding  three  weeks.  More  than  a  year 
afterward,  December  11,  1882,  Pasteur  and  his  collaborateurs 
made  a  further  announcement,  in  which  they  promulgated  the  fol- 
lowing facts  : — 

I.  Dumb  madness  and  furious  rabies,  in  fact  all  kinds  of 
rabies,  proceed  from  the  same  virus. 

II.  The  symptoms  of  rabies  are  infinite  in  variety.  Each  case 
has  its  own,  and  their  character  depends  on  the  nature  of  the 
points  of  the  nervous  system, —  brain,  spinal  cord  —  at  which  the 
virus  localizes  itself  and  is  cultivated. 

III.  As  in  the  rabic  saliva  the  virus  is  found  associated  with 
different  microbes,  its  inoculation  may  give  rise  to  death  in  three 
ways : — 

1.  Death  by  rabies. 

2.  Death  by  (pyaemia)  excessive  development  of  pus. 

3.  Death  by  reason  of  the  microbes  which  he  had  made  known 
as  the  saliva  microbes.  In  December,  1880,  he  had  inoculated 
two  rabbits  from  the  saliva  of  a  child  who  had  died  mad  in  the 
hospital  Saint  Eugenie.  These  rabbits  died  in  36  hours ;  others 
inoculated  from  these  died,  and  so  on  through  several  series.  A 
microbe  was  discovered  in  the  blood.  Subcutaneous  injections  of 
this  blood  failed  to  produce  madness  in  dogs.  He  first  supposed 
this  to  be  the  microbe  of  rabies,  but  soon  determined  that  this  was 
not  the  case,  as  it  was  found  in  the  saliva  of  a  healthy  man,  and 
rabbits  inoculated  by  M.  Vulpian  with  it  died. 

IV.  The  medulla  oblongata  of  people  and  animals  who  have 
died  of  rabies  is  always  virulent. 

V.  Rabic  virus  is  found  not  only  in  the  medulla,  but  also  in  the 
whole  or  part  of  the  encephalon.  It  is  found  localized  in  the  cord 
and  often  in  all  parts  of  the  cord.  The  virulence  in  the  cord 
equals  that  of  the  medulla  or  portion  of  the  encephalon.  Viru- 
lence remains  as  long  as  putrefaction  does  not  set  in.  The  viru- 
lence of  a  rabic  brain  was  kept  for  three  weeks  at  a  temperature 
of  12  degrees  c. 

VI.  To  develop  rabies  certainly  and  rapidly,  inoculation  must 


10  < 

be  made  on  the  surface  of  the  brain  under  the  dura  mater  by 
means  of  trepanation.  These  results  are  also  obtained  by  in. 
travenous  injection.     Madness  often  declared  in  six  or  seven  days. 

VII.  Eabies  brought  on  by  intravenous  injection  differs  from 
that  produced  by  bites  or  trepanning.  It  is  possible  that  many 
cases  of  this  silent  madness  have  been  passed  over.  In  these 
cases  [of  medullary  rabies,  prompt  paralysis  is  frequent,  fury  of- 
ten absent,  rabic  howling  rare,  while  on  the  other  hand,  frightful 
itching  and  tearing  take  place.  Our  experiments  have  led  us  to 
the  conclusion  that  in  intravenous  inoculation,  as  far  as  we  can  de- 
termine, the  spinal  marrow  is  first  attacked ;  that  is  to  say,  the 
rabic  virus  first  fixes  itself  there  and  is  propagated. 

VIII.  Inoculation  of  rabic  saliva  or  blood  not  followed  by  death, 
in  intravenous  injection  in  the  dog,  does  not  protect  against  sub- 
sequent madness  and  death,  upon  a  fresh  inoculation  of  pure  rabic 
material  introduced  by  trepanation  or  intravenous  inoculation. 

IX.  Cases  of  spontaneous  cure  are  met  with  after  the  appear- 
ance of  the  first  symptoms,  never  after  the  severe  symptoms  have 
appeared.  In  certain  cases  the  severe  symptoms  appeared  much 
later  and  were  followed  by  death. 

X.  In  one  case,  out  of  three  dogs  inoculated  in  1881,  two  died 
shortly  of  rabies,  and  the  third,  after  having  shown  the  first  sj^mp- 
toms,  got  well.  This  dog,  although  reinoculated  hy  trepanation 
twice  in  1882,  did  not  become  mad. 

XI.  Three  other  dogs  could  not  be  made  rabid  even  with  the 
strongest  virus.  Did  these  become  refractor^'  by  reason  of  a  mild 
rabies  cured?  or  is  it  that  some  are  naturally  so? 

These  propositions  are  the  result  of  over  200  experiments  on 
dogs,  rabbits  and  sheep.  In  this  report  Pasteur  first  propounds 
the  idea :  It  is  possible  to  render  man  refractory  to  rabies. 

In  his  communication  to  the  Academy  of  Sciences,  dated  Febru- 
ary 25,  1884,  Pasteur  reaffirms  his  statements  made  December  11, 
1882,  and  amplifies  them,  giving  the  results  of  various  experi- 
ments verifying  them.  He  announced  that  he  had  succeeded  in 
rendering  dogs  refractory  to  rabies.  The  virus  was  found  located 
also  in  the  nerves  of  the  peripher}-,  as  well  as  in  the  central  ner- 
vous system  and  salivary  glands.  He  said  tliat  different  quanti- 
ties of  virus  inoculated  gave  rise  to  different  sj'mptoms  ;  a  small 
quantity  to  furious  rabies,  a  larger  quantity  to  dumb  rabies.  At- 
tention is  then  called  to  the  fact  that  the  discovery  of  the  attenua- 


11 

tion  of  a  virus  and  the  application  made  of  this  fact  to  prophy- 
laxis in  certain  diseases,  had  brought  to  light  this  fact  of  the  pos- 
sible experimental  production  of  the  different  grades  of  virulence 
of  a  virus.  Rabies  is  essentially  a  disease  produced  b}'  a  virus. 
Can  different  degrees  of  a  rabic  virus  be  obtained?  The 
answer  is  yes.  In  different  animals  the  virulence  varies,  and 
passing  it  from  one  animal  to  another  of  the  same  species  it 
finally  becomes  of  fixed  strength. 

On  May  19,  1884,  the  following  fact  was  announced:  In  passing 
the  rabic  virus  from  monkey  to  monkey  it  gradually  becomes  les- 
sened in  strength,  so  that  finally  it  is  incapable  of  giving  rabies  to 
a  dog  by  hypodermic  injection.  With  rabbits,  on  the  contrary, 
the  virus  increases  in  strength  in  passing  from  one  to  another,  and 
finally  it  reaches  a  fixed  period  of  incubation  of  seven  days. 
Pasteur  now  declared  that  he  had  arrived  at  a  principle  of  render- 
ing dogs  refractory  to  madness,  and  asked  the  minister  of  public 
instruction  to  appoint  a  commission  to  examine  and  report.  The 
commission  was  appointed  as  follows  :  Messrs.  Beclard,  P.  Bert, 
Bouley,  Tissorand,  Villemin,  Vulpian.  They  reported,  August  6, 
as  follows  :  Of  the  19  dogs  experimented  on,  three  out  of  six  bitten 
by  rabic  dogs  died  ;  six  out  of  eight  subjected  to  intravenous  inocu- 
lation of  rabic  material  died ;  five  out  of  five  inoculated  by  trepan- 
ation died.  Of  the  25  vaccinated  dogs  (rendered  refractory  by 
Pasteur)  none  were  attacked  by  rabies.  One  died  of  diarrhoea  on 
the  seventh  day ;  however,  to  be  certain  that  it  had  not  died  of 
rabies,  three  rabbits  and  a  guinea-pig  were  inoculated  from  its 
cord  and  did  not  become  mad. 

On  the  25th  of  October,  1885,  Pasteur  made  the  report  to  the 
Academy  in  which  he  announced  his  treatment  as  applied  to  human 
beings  and  its  application  to  the  case  of  Joseph  Meister  some  time 
previous.  In  addition  to  the  principles  mentioned  above  the  fol- 
lowing are  intimately  connected  with  this  process : — 

The  inoculation  under  the  dura  mater  of  a  rabbit  by  means  of 
trepanation  of  the  rabic  cord  of  a  dog  dead  of  ordinary  rabies, 
produced  rabies  in  about  15  days.  If  the  virus  of  this  rabbit  is 
passed  to  a  second  and  from  this  to  a  third  and  so  on,  there  soon 
is  a  decided  tendency  for  the  period  of  incubation  to  shorten. 
After  25  passages  the  period  of  incubation  becomes  eight  days, 
and  finally,  after  25  more  passages  seven  days  ;  here  it  remains 
fixed.  (After  110  passage^  some  showed  signs  in  six  da^-s.) 
These  cords  are  virulent  in  their  whole  extent. 


12 

If  short  pieces  of  cord  are  taken  and  suspended  in  sterilized  jars 
n  which  the  air  has  been  rendered  dr}'  b}*  means  of  small  pieces 
)f  caustic  potash  placed  in  the  bottom,  the  virulence  will  disappear 
ittle  by  little  until  it  is  entireh*  extinct,  depending  upon  the  length 
>f  time  kept,  the  temperature  and  the  thickness  of  the  cord, 
rhese  results  constitute  the  scientific  point  of  of  the  method.  The 
:ord  is  dissected  each  day  from  a  rabbit  dead  that  day  and  care- 
uU}^  put  awa}^  in  jars.  Each  day  fresh  rabbits  are  inoculated 
vith  the  virus  taken  from  rabbits  dead  that  day  so  as  to  keep  up 
he  series.  In  order  to  induce  the  refractory  state  in  man  or 
inimals,  successive  inoculations  are  made,  beginning  with  a  virus 
;ufl3ciently  old  to  have  lost  all  its  strength,  and  day  by  day  in- 
;reased  till  that  which  is  finally  given  if  it  had  been  first  given 
vould  have  produced  rabies.  In  order  to  introduce  the  poison 
nto  the  system  a  very  small  piece  is  rubbed  up  with  sterilized  broth 
md  introduced  under  the  skin  by  means  of  a  hypodermic  s^'ringe 
n  the  hypochondriac  region. 

Originally  Pasteur  began  with  virus  15  daj's  old, —  that  is  hav- 
ng  been  kept  in  the  desiccating  jar  that  length  of  time, —  and 
iuished  with  virus  one  day  old,  given  13  inoculations  in  10  days  ; 
low  he  begins  with  14-da3'-old  virus  and  ends  with  five-day-old, 
>ne  inoculation  being  given  each  day. 

The  claim  on  which  the  treatment  of  those  bitten  is  maintained 
s  as  follows  :  The  ordinary  period  of  incubation  after  the  bite  of 
I  rabid  dog  being  about  six  weeks,  if  we  can  before  that  time  in- 
;titute  a  refractory  state  in  man  the  poison  will  not  act.  Inocnla 
ions  with  the  strong  virus  taken  from  the  rabbit  do  this  in  a 
horter  time,  so  the  rabies  produced  by  the  dog-bite  is  warded  off. 
rhe  system  has  become  accustomed  to  the  poison  b}'  the  gradually 
ncreasing  strength  of  the  dose  thereof.  This  foundation  principle 
3  sound,  and  the  application  is  possible  so  long  as  we  are  able  to 
;et  a  diminulation  in  the  strength  of  the  virus.  These  problems 
lave  been  worked  out  by  Pasteur  and  practically  applied  with 
uccess. 

Let  us  look  for  a  moment  at  some  statistics  given  by  Dr. 
Jrancher,  who  has  performed  Pasteur's  inoculations  on  human 
)eings  for  him.  The  report  was  made  in  June,  but  the  period  of 
ncubation  in  rabies  derived  from  the  dog-bite  being  long,  only  the 
!ases  up  to  April  22  were  taken.  The  cases  were  divided  into 
,hree  classes.     First-class — Those  bitten  by  dogs  proved  to  be  mad 


13 

by  inoculation  of  rabbits  or  subsequent  development  of  rabies  in 
animals  bitten  by  them — 96  cases,  one  death. 

Second-class — Patients  bitten  by  dogs  certified  to  be  rabid  by 
the  veterinary  practioners  of  the  locality, —  644  cases,  three  deaths. 

Third-class  — Those  bitten  by  dogs  who  had  run  off  and  not 
been  seen  again  —  232  cases,  no  deaths. 

In  the  first  two  classes  740  cases  with  three  deaths,  not  quite 
one-half  per  cent,  of  those  bitten  ;  while  the  ordinary'  statistics  of 
like  cases  given  by  M.  Leblanc,  veterinary  surgeon  of  the  city  of 
Paris,  give  16  per  cent,  as  the  number  of  deaths.  Dr.  Brouardel 
has  calculated  that  no  less  than  80  per  cent,  of  those  bitten  by 
rabid  dogs  on  exposed  parts  of  the  body  die.  Of  the  84  cases  of 
wolf-bite,  not  included  in  the  above,  seven  died.  Ordinarily,  66 
per  cent  of  those  bitten  by  rabid  wolves  died,  and  here  the  per- 
centage is  6.  Looking  at  these,  shall  we  not  say  the  principles 
and  methods  are  a  success?  During  the  month  of  April  last  I  vis- 
ited Pasteur's  laboratory,  as  the  representative  of  the  American 
Pasteur  Institute.  I  was  kindly  received  by  him  and  his  assist- 
ants, and  everything  in  the  process  of  his  method  of  inoculation 
shown  me,  from  the  primary  trepanation  and  introduction  of  the 
virus  under  the  dura  mater  of  a  well  rabbit,  to  the  inoculation  of 
a  human  being  with  the  spinal  cord  of  a  rabbit  which  had  died 
with  rabies.  All  the  steps  were  shown  me ;  nothing  was  con- 
cealed. Upon  leaving  Paris,  a  rabbit  inoculated  that  day  was 
given  me.  This  rabbit  was  my  constant  care  for  the  next  nine 
days,  when  it  died,  having  developed  signs  of  paralysis  two  days 
before.  I  immediatelj'  placed  the  body  on  ice,  and  on  the  next 
da}',  having  arrived  here,  the  spinal  cord  was  dissected  out,  and 
the  work  of  propagating  the  virus  begun.  Rabbits  were  inocu- 
lated every  day  for  several  days,  the  cord  being  kept  in  carbonic 
acid  gas  at  a  low  temperature.  Those  rabbits  developed  rabies  in 
due  course,  and  after  a  time  a  series  was  established  and  the  work 
was  begun  on  the  human  being.  In  the  first  case,  unfortunately', 
the  patient's  health  was  such  that  his  parents  discontinued  the  in- 
oculations, after  the  fourth.  The  trouble  did  not  arise  from  the 
inoculations,  but  from  a  series  of  accidents  which  happened  to  the 
lad  (who  was  only  seven  years  old)  immediately  before  the  begin- 
ning or  during  the  time  of  the  inoculations  —  he  having  been  hit 
with  a  stone  and  badlj'  cut ;  having  fallen  down  the  Elevated  rail- 
road stairs,  which  was  followed  by  severe  epistaxis  ;  having  cut  his 


14 

wrist,  and  a  good-sized  branch  of  the  ulnar  artery,  so  that  there 
was  a  great  deal  of  hemorrhage  ;  as  well  as  having  suffered  severely 
from  the  bite.  In  the  second  case,  the  inoculations  were  taken 
through  the  whole  series,  the  patient  is  doing  well,  not  having  suf- 
fered any  inconvenience  from  the  treatment.  The  same  may  be 
said  concerning  the  third  and  fourth  cases.  In  two  out  of  the 
last  three  cases  the  dogs  were  undoubtedly  mad,  all  the  symptoms 
pointing  that  way.  In  the  other  case  there  were  sufficient  indica- 
tions to  warrant  the  treatment,  especially  as  the  parents  were 
anxious  to  have  it  done. 

I  have  also  inoculated  myself  as  a  means  of  prevention.  A 
number  of  people  have  come  to  me  at  various  times,  having  been 
bitten,  wishing  to  know  if  inoculation  was  necessary  —  in  many 
cases  much  frightened  and  in  an  excessively  nervous  state.  I 
have  been  able  to  allay  their  fears,  assuring  them  from  the  detailed 
circumstances  of  the  absolute  absence  of  danger,  and  after  some 
slight  treatment  for  their  nerves  and  dressing  of  the  wounds,  they 
have  gone  home  happy  and  contented.  Many  more  points  in  the 
study  of  rabies  might  be  brought  forward,  for  it  is  a  subject  re- 
plete with  interest  and  worthy  of  research.  If,  however,  I  have 
succeeded  in  implanting  in  your  minds  a  few  of  the  points  con- 
cerning it,  and  a  belief  in  the  efficacy  of  the  method  of  inocula- 
tion as  a  means  of  prevention,  I  shall  be  satisfied  with  my  success. 


Date  Due 

^ 

RC148 
Mott 

WAR  2  Z   id 38 


M85 


C  U.  Bi7>JDEpy 


1^ 


